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Perspective and Spirituality

It took me about three weeks to get from my strangely embarrassed general practitioner's admission that I have gotten some bad numbers on my prostate cancer blood test to the Big Day when I got the definitive biopsy results.

“Don’t worry too much” the urologist had told me during the biopsy as he punched another needle into my prostate. (It made a sound like someone pulling the trigger on an unloaded gun). “With your blood test numbers you have about a thirty percent chance of actually having it.” I found these words reassuring and tried very hard to only be thirty percent terrified for the next ten days.

On the Big Day the urologist came into the little room where my wife and I were waiting and he was brimming with optimism. (But why not? He is a surgeon, so even if the news was bad I’d still have an opportunity to get surgery).

“Now let’s see. We did 12 biopsy cores and 11 came back entirely benign. But the 12th one had cancer.”

Seeing the shocked look on my face he hastened to reassure me.

“It’s just one small section, which is very good. Unless you have a lot of cancerous sections all over the place and we happened to miss them with the needle biopsy. Then it’s not so good. With cancer, we recommend surgery or radiation treatments (I’d go with the surgery, but then, I’m a surgeon) or we can do what’s called “watchful waiting” where we don’t do anything and then retest every year until we find something worse that requires surgery or radiation. Your cancer is probably low risk and I don’t think that you would be risking too much to just wait and see. Unless it turns out that it is actually very aggressive, in which case you shouldn’t wait at all. All in all, the cancer will probably kill you eventually if you don’t do anything about it, but the good news is that you are just as likely to die of something else first. It’s up to you. It probably depends on how lucky you feel.”

Having just been told that I have cancer, I must admit that I wasn’t feeling very lucky at that particular moment. At that moment, my prostate, a walnut sized gland in my pelvis that I had never paid attention to before felt like it was the size and shape of a manhole cover. I wasn’t in any pain and I had no evident symptoms of any sort. It’s just that the little gland suddenly loomed large in my consciousness. I must have looked distracted at that point and the doctor hastened to reassure me.

“If you decide on surgery (and I’m not trying to steer you in any direction although if I were you I’d have the surgery), we use a big robot nowadays named Da Vinci to assist. There are almost no complications except for occasional heavy bleeding and once in a blue moon a stroke or heart attack. After all, it’s major surgery. But you are relatively young so I would not expect you to experience any of these or have any serious side effects, which are mostly permanent impotence and permanent incontinence. But even if that happens, we have surgical and other remedies for it so that we can pretty much more or less take care of it. (Here he launched into a disturbing list of available prosthetics.) Take a few weeks and talk to your wife. Get a second opinion, maybe even from a radiologist. And then come back with your decision. In the meantime, relax and don’t worry.”

It’s a strange thing to be told that one has cancer. I mean, cancer! And in getting cancer, if I ending up beating it, I would become a cancer survivor. The fact that I had just a bit of cancer didn’t mean anything. It still counted as cancer. When the initial fog of panic cleared, I saw that I had the usual two issues. The first was the technical issue of what to do about it. And the second was the spiritual issue of being reminded in a vivid way of my mortality.

The technical issue turned out to be relatively easy to deal with. After all, it’s all about techniques and the odds. In the end it comes down to a sort of mathematical equation, albeit one that includes one’s own personality tendencies and outlooks on life. There are plenty of books out there and experts to help one get through this. In general, it appeared that the educated person at least would simply consult the books and the experts until a solution revealed itself.

The spiritual side was trickier. As a Christian, I was already supposed to be keeping death in plain view at all times. Being told that I had cancer should not have changed this very much, which means that having a nasty disease shouldn’t have much of a spiritual effect on me, if, of course, I have really been keeping up with the spirit of Christianity. But naturally, I found out that I really hadn’t been. When push came to shove, I had believed that I would live forever, just like everyone else. So now what?

And so it was for spiritual advice rather than technical advice that I found myself going to the book The Decision: Your prostate biopsy shows cancer… Now What? By Dr. John McHugh.
McHugh is a urologist who got prostate cancer himself and in the book he (first of all) documents the steps that he took to decide what to do about it. The book is not so much a handbook on options (although it is that) as much as a handbook on decision making. But in the book he also talks about what it’s like to have prostate cancer and to go through the aftermath of treatment, from the point of view of a doctor who had been reassuring his patients for years about how everything would probably be fine unless it wasn’t. The book is surprisingly humorous (note that he is wearing a catheter outside of his scrubs on the cover of the book) as the doctor talks about the challenges of wearing a catheter and adult diapers for several weeks with dignity (for example) or dealing with the inevitable sexual side effects even from an overall successful operation.

It’s not specifically a book on the Christian spirituality of taking bad news. But I nonetheless found it helpful in that regard, because for me, the spiritual problem of having cancer was in putting it in perspective. Perspective is what creates a space where I can then deal with this spiritually. Cancer is not, in fact, killing me at the moment (as far as I know) and my personal situation had not in fact changed very much in the period where I was diagnosed. Or to put it another way, one of the facts of our life is our basic frailty as humans (both physically and spiritually) and getting bad news like this doesn’t change that fact one iota. It merely confirms it as we could confirm it dozens of times a day if we wanted (or dared) to. We can look at our frailties in a grim manner if we want (since all roads lead to decay and death), but if we have a spirituality that affirms life our frailties become funny in a way. McHugh telling the story of having a major dinner party at his house is actually funny. He refuses to tell anyone that he recently had major surgery and that he will need to leave the yard and freshen up (his Depends) frequently, opting instead to pretend that all is normal and to tough it out. This causes him to not very subtly attempt to freshen up using removable pads, where he constantly steps away to the bushes or behind the garage for a few moments to do a quick change. This leads to pads being hidden all over the place until his dog finds one and the jig is up. Very human this, very frail yet very funny. Spirituality in the context of the realities of human physical existence is very much a function; it seems to me, of perspective. If we love, we have to laugh. And if we laugh, we have to love. And the book is a very loving and laughing account of what to do what one gets the bad news.

Comments

Unaguidon deserves not only our prayers but also our thanks for his very thoughtful comments. Thinking well about the fact that each of us has, sooner or later, a death to die, is integral to Christian living and, as Louis Bouyer showed many years ago, to accepting Jesus' call to share in His passion, death and resurrection.

As a shamelessly proud father-in-law, let me mention that my daughteer-in-law, Ansley Dauenhauer, is a survivor of breast cancer who has written a novel called "Cancer Slam" that is meant to help cancer victims who are mothers of young children talk with their families about what the treatment and its side effects are like. Her book carries the recommentation of one of the oncologists at Sloan-Kettering. She doesn't deal with death, but does shed light on living well with a serious illness.

I will say this about doctors: they depend on what you tell them. Yesterday I went to the doctor, suggested two choices of what's ailing me, he picked one, and gave me pills. If that's doesn't work, he will go for a scan and maybe choose the other suggestion. They do have the Shaman about them, don't they.

Now the story you just posted makes more sense: it's about the unreasonable invulnerability of youth, isn't it? Or about your general good luck in life?

As a Christian, I was already supposed to be keeping death in plain view at all times. Being told that I had cancer should not have changed this very much, which means that having a nasty disease shouldn’t have much of a spiritual effect on me, if, of course, I have really been keeping up with the spirit of Christianity. But naturally, I found out that I really hadn’t been. When push came to shove, I had believed that I would live forever, just like everyone else.

I always wonder about that. When I try to weigh the advantages of being undead vs. being dead, in the end it all boils down to the company I will keep: do I have more friends on this or on the other side of death? Do I prefer separation from the people I love down here by preceding them, and then having to wait for them to join me, or by their preceding me and then I will have to wait until my turn comes? Not that I can choose, of course. Will Christ be closer to us after we die? Are we finally, at the long last, be able to be in him and he in us with nothing at all coming between us? Will I really have enough faith and hope to go forth without being scared?

Sorry I'm all speaking in the abstract. I have not yet encountered death by disease in my generation, among either family or close friends - I am still in the "feeling invulnerable" stage, so musing abstractly comes more naturally than Bernard's immediate sympathy...

In France and Italy, as in other countries, doctors routinely concealed diagnoses from patients. Cancer and tuberculosis were too shameful to discuss openly. See, e.g., the behavior of the doctor who treated Therese of Lisieux. Guy Gaucher describes it in The Passion of Therese of Lisieux.

". . . the doctor may not have used the word 'tuberculosis' earlier, for at that time the word was taboo, just as 'cancer' is today." (1973)

I had a biopsy several years ago. Anesthetic applied up the ying-yang: not the most pain-free experience. Still painful each time the urologist snipped a sample. A friend a few years earlier also had a biopsy with NO anesthetic! He elected the radiation seed treatment after getting positive results. Been doing fine ever since. Unigidon, what are your thoughts on CyberKnife treatment?

Unagidon, been there, done that. You'll survive. I am told that if it recurs, at my age, we'll just live with it because I'll die of something else before it gets to me.

You will find waiting roomsful of gabby old men eager to tell you about their experience with it, so I will spare you. Except to say that I went with radiation and had a (generally) good time with no down time except the hour or so spent going, being treated and coming home for 45 dlays.

Ok, it occured to me that the non-survivors were unlikely to post comments, so I asked my internet brower for statistics, and found that the 5-year survival rate is 100%. Huh? For cancer? Now I feel cheated.

I've had a biopsy also, unagidon, and you aptly described the sound as "like someone pulling the trigger on an unloaded gun." No cancer, luckily, but I'm now on a regimen of annual PSA blood testing and twice yearly rectal exams, (Just can't wait for February and July to roll around each year! :) ) You noted the DaVinci Robot as a possible surgical option. While I've read that it has had a good record overall, a recent expose reported that it has also resulted in some major post-surgical complications for some patients:

The survival rate is high. It's the complications at this point that are the bigger concern.. I am young enough (and still have young children) where I have to look beyond a five year horizon. So I am likely going to have the surgery rather than the radiation treatment.

The surgical complication rate is only as good as the surgeon and whether he/she is having a good day or not. The recovery period will be a drag, but like a good cupcake I shall just have to suck it up.

My doctor's monologue was pretty much as I reported it, where he hedged everything and covered all bases simultaneously. Mostly this is one of the least complicated cancers to have. But then there are the Frank Zappas of the world that it kills in a few years flat. I suppose it depends on whether I'm feeling lucky.

unagidon - you may be tuned into this already, but there are cancer patient support groups that may be able to help you with the spiritual dimensions of being a cancer patient. Even though the survival rates being reported here are great news, I would guess it's casting a gigantic shadow over your life. Email me privately if you'd like some help tracking down groups in our area, and I'll see what I can do.

You are in my prayers, I can empathize, though I'm sure that such news is much, much worse for a young person. A while back I had a similar scare. In my case the only question was how long I had to live -- the odds were almost completely against me. But mine was an "extremely rare" case, said the doctors, and I beat the odds. Lesson: even bad odds can be wrong.

Whenever I hear someone discuss a prostate cancer diagnosis, I feel compelled to mention this book. I remember hearing interviews with the authors when it came out a few years ago and being impressed. It is certainly a disease with a strong prognosis. Good luck.

I Went through this in 2005. Had the radical prostectomy, and my psa levels have been vanishingly low ever since. So I know what you're going through, and I'll say some prayers for you. Your chances are very good, depending on how long the cancer has been present, and whether it happens to be an exceptionally aggressive form, which I understand is rather uncommon. It is a stressfull and scary ordeal, but I think you'll be OK; I will certainly pray that you will be.

Unagidon - thank you for your post and the "yes" that led to your decision to offer it to a complete stranger like me. Earlier today, as you were posting the story, I was on my way to my own prostate biopsy. Like you, I have been thinking a lot about my own mortality since the doctor told me I needed this biopsy, along with some soul searching about whether I am as much a believer as I like to think I am. Filled with those fears and doubts, the Spirit led me to your post as I searched for a little spiritual inspiration on Commonweal. From a very human perspective, your story helped me face honestly and with humor the events of my big day, a day I am doing my best to downplay with my family. So thanks for that; I can now go to bed knowing that I have some new friends who understand what I just went through. That helps. But more significantly, your post, coming as a complete surprise and at the precise time when I needed it most, was nothing less than an affirming and deafening message, "be still and know that I am God." In other words, your post was God's presence in my life today; my "close moment to Christ," an affirmation that I am not alone as I face my struggles and doubts. So thanks very much for that too. I will pray for you in the days ahead and regardless of the news I receive 7 days from now, know that I will receive it with my faith reaffirmed by your humble, faithful and loving "yes" to share your humanity with the hope that it would help others -- which it has.

Obviously, I will not have to deal with the threat of prostate cancer personally. (Hopefully, my levity is not inappropriate.)

But, I have relatives and friends who have dealt with breast cancer, throat cancer, colon cancer, and leukemia. A cousin died last week after a valient battle with ovarian cancer. So, fears about cancer weigh heavily on my mind at times.

Let me tell you that if ever I have have a diagnosis of cancer, Unagidon, I will go to this post and read it again for support, perspective and strength.

One's mortality has a nasty habit of asserting itself at the most inopportune moments. I had a pacemaker installed about 2 years ago and just a few days ago discovered that it needed some serious adjusting RIGHT NOW.

That will scare the bejeepers out of one ... as it did to me.

For those of you with good health, treasure it as your health is truly one of the most precious gifts that you have been given .... and never, never, never take it for granted, particularly once you pass 50.

There was excellent news yesterday on the cancer front. There is a particularly ugly little animal called "the naked mole rat" which has been the object of scientific research for some time. Scientists have discovered the chemical substance which is abundant in their bodies which prevents their getting cancer -- ever. They just don't get it. The scientists are very hopeful that research into this substance will probably help with finding a human cure. Take heart, everyone. Added moral: never think that what is extraordinarily ugly is useless.

Ann - as a matter of fact, one of Disney's cable TV channels, the Disney Channel, had an animated series during the last decade called Kim Possible, one of whose characters was ... a pet naked mole rat named Rufus.

Spirituality has been defined in various ways. For instance ,: a belief in a strength operating in the world which is greater than oneself, a sense of interconnectedness with all living things, and an awareness of the purpose and meaning of life and the progression of personal, absolute values. It is the way you find meaning, hope, comfort, along with inner serenity in your life. Even though spirituality is frequently associated with religious life, believe that spirituality may be developed away from religion. Operates of compassion and selflessness, altruism, along with the experience of inner peace are characteristics associated with spirituality.

I went for a second opinion to Dr. Peter Carroll of the University of California Medical Center (and a leading urologist), whom I strongly suggest you Google. He has me on an "active surveillance" program (quarterly PSAs, semiannual ultrasounds, yearly biopsies), as I almost fit into the PSA/Gleason profile that can afford to wait in anticipation of the quite possible outcome that the cancer will never develop into a severe problem. The following is a quote from a San Francisco Chronicle article about one of Dr. Caroll's patients, with a link.

When I went in to see Peter I said, "I'm young and I'm healthy, so I should probably have surgery." He said, "Do you want another opinion? I agree you're healthy, you're young, (you don't) have aggressive, early-stage disease, and I have a different opinion. Do nothing." http://tinyurl.com/ln67yj3

P.S. "Active surveillance" not the same thing as "watchful waiting," though can't remember now what "watchful waiting" is, exactly, except that it is less rigorous. I asked Dr. Carroll if any cancers in the active surveillance program had "gotten away," so to speak, that is metastasized or penetrated the prostate capsule before treatment was started. He said no. I forget how many patients were in the program when I asked him that. Maybe 1600. In the following link, Dr. Carroll discusses active surveillance. http://www.ucsfhealth.org/education/interview_carroll_active_surveillance_for_prostate_cancer/

Please forgive me for commenting late (1/17/2014) on your diagnosis of prostate cancer but I've only just now read your excellent blog.

I'm close to 80 and have never had such a diagnosis but my younger brother had one 15 years ago, at age 60. After experiencing all the nasty side effects of an enlarged prostate, he was told he had cancer of that organ. Even though he was in severe discomfort, he took the time to search the internet for an alternative to surgery and radiation (which were applied to two of our uncles one of whom died in agony from its effects) and found one. It involved placing a pellet of dry ice in the prostate which would kill it and then allow the body to gradually clear out the dead tissue. It took 6 months of negotiating with his insurance company to get them to approve and pay for it because it was not an accepted surgical procedure (they went for it based, almost solely, on the much lower cost relative to that of the standard medical practice of slice, bake and poison - i.e. surgery, radiation and chemo). The results were as expected and his recovery was very mild. The negative effect of loss of sexual prowess was cured later on by having a balloon surgically inserted into his primary male sexual instrument, which, he tells me, has radically improved his relationship with the opposite sex.

We did not know it at the time but his body was dealing with a much more serious issue of clogged arteries which didn't manifest itself until a couple of years later resulting in a quadruple bypass and partial replacement of one of his arteries. His surgeon told him that if they had known about his condition back when the prostate surgery took place he would never have qualified for it based on the high probability of him dying on the table. It was the mildness of the surgery and his recovery from it that probably saved his life, thank God.

And, spiritually speaking, I do try to thank God every day for all that he has injected into my life, both the good and the "bad", for the purpose of trying to bring me closer to Him. I wish I were closer to Him than I am, but that is my fault and not his.

I've had the rare privilege, over many years now, of being in a prayer group of truly Christ centered catholic men who pray for the recovery of those who are sick or have the potential of becoming seriously ill. If you don't mind, I will enter your name of those we pray for. Please pray for me, especially my spiritual side or lack therof.